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Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT

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A Correction to this article was published on 03 July 2023

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Abstract

Introduction

Surgical treatment for Hirschsprung disease (HD) has recently evolved into different minimally invasive techniques. The aim of the present study is to compare results from two different minimal invasive approaches, transanal endorectal pull-through (TERPT) and laparoscopic-assisted endorectal pull-through (LA-TERPT).

Methods

Patients have been divided into two groups according to surgical technique. Data of HD patients treated by TERPT and those treated by LA-TERPT, respectively, performed at two different centers from January 2007 to December 2017, were retrospectively collected. Patients with aganglionosis confined to the recto-sigmoid colon with a minimum follow-up period of 4 years have been included. Demographic, clinical, surgical and functional outcome data were reviewed for each group using Chi-square and Fisher tests (statistical differences were considered for p < 0.05).

Results

Among patients treated for HD in the two centers during the study period, 65 met the inclusion criteria (37 TERPT group and 28 LA-TERPT group). No differences regarding demographic and clinical data were observed between the two groups. Operative time was longer in the LA-TERPT group (p < 0.001). Time to start oral feeding was faster in the TERPT group while hospital stay was similar between the two groups. Three patients of the TERPT group required an additional abdominal approach. The rate of early complications was higher in the TERPT group. Long-term bowel function was assessed in 31 patients for the TERPT group and 24 patients for the LA-TERPT group. Outcomes showed that the bowel functional outcome was good (BFS ≥ 17) in 55% (n = 17) of TERPT group and 54% of LA-TERPT group (p = 0.97), moderate (BFS 12 to 16) in 16% (n = 5) and 33% (n = 8), respectively (p = 0.24), and poor in 29% (n = 9) and 13% (n = 3), respectively (p = 0.23).

Conclusions

Both TERPT and LA-TERPT techniques should be considered safe and feasible for the treatment of HD patients. TERPT patients present faster time to return to normal bowel function while LA-TERPT patients have slightly lower incidence of postoperative complications. Long-term functional outcomes are similar between the two groups.

Level of evidence

III.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Change history

Abbreviations

HD:

Hirschsprung’s disease

LA-TERPT:

Laparoscopic-assisted transanal endorectal pull-through

TERPT:

Transanal endorectal pull-through

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Author information

Authors and Affiliations

  1. Department of Neonatal and Emergency Surgery, Meyer Children’s Hospital, Florence, Italy

    Noemi Cantone, Andrea Zulli, Elisa Severi, Tocchioni Francesca, Centonze Nicola & Noccioli Bruno

  2. Pediatric Surgery Unit, IRCCS Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 11, 40138, Bologna, Italy

    Vincenzo Davide Catania, Eduje Thomas, Libri Michele, Gargano Tommaso & Lima Mario

  3. Department of Pediatric Surgery, Hospital “Santa Chiara” APSS of Trento, Trento, Italy

    Ciardini Enrico

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  1. Noemi Cantone
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Contributions

CN, CVD, NB and ML contributed to conception and design of the study. ZA, TE, SE, TF organized the database. CN, CNic, CE performed the statistical analysis. CN, CVD, LM and GT wrote the first draft of the manuscript. ZA, TE, GT, and TF wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

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Correspondence to Vincenzo Davide Catania.

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Cantone, N., Catania, V.D., Zulli, A. et al. Comparison between two minimally invasive techniques for Hirschsprung disease: transanal endorectal pull-through (TERPT) versus laparoscopic-TERPT. Pediatr Surg Int 39, 198 (2023). https://doi.org/10.1007/s00383-023-05473-3

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